Dermatomyositis pathophysiology: Difference between revisions

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==Overview==
==Overview==
The underlying mechanism of dermatomyositis is conjectured to be [[Complement system|complement]]-mediated damage of the microscopic vessels with [[muscle atrophy]] and lymphocytic inflammation secondary to tissue [[ischemia]]. On microscopy, both [[B-cell]] and [[T-cell]] infiltrate are seen.
==Pathophysiology==
==Pathophysiology==
The diagnosis of dermatomyositis can be confirmed by muscle biopsy, [[EMG]], and blood tests. It should be noted, however, that only muscle biopsy is truly diagnostic (pathognomic); liver enzymes and EMG are relatively non-specific. Liver enzymes, specificly creatine phosphokinase (CPK), are the major tool in assessing the progress of the disease and/or the efficacy of treatment. On the muscle biopsy, there are two classic microscopic findings of dermatomyositis.  They are:
On the muscle biopsy, there are two classic microscopic findings of dermatomyositis.  They are:
 
* A mixed [[B-cell|B-]] and [[T-cell]] perivascular inflammatory infiltrate
* A mixed [[B-cell|B-]] and [[T-cell]] perivascular inflammatory infiltrate
* Perifascicular muscle fiber atrophy
* Perifascicular muscle fiber atrophy
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===Mechanism===
===Mechanism===
The mechanism is conjectured to be [[Complement system|complement]]-mediated damage of microscopic vessels with muscle atrophy and lymphocytic inflammation secondary to tissue [[ischemia]].<ref>{{cite journal | last=Benveniste | first=O | coauthors=Squier W, Boyer O et al. | title=Pathogenesis of primary inflammatory myopathies | journal=Presse Médicale | volume=33 | issue=20 | pages=1444–1450 | month=November | year=2004 | pmid=15611679 | doi=10.1016/S0755-4982(04)98952-X }}</ref>
The mechanism is conjectured to be [[Complement system|complement]]-mediated damage of microscopic vessels with muscle atrophy and lymphocytic inflammation secondary to tissue [[ischemia]].<ref>{{cite journal | last=Benveniste | first=O | coauthors=Squier W, Boyer O et al. | title=Pathogenesis of primary inflammatory myopathies | journal=Presse Médicale | volume=33 | issue=20 | pages=1444–1450 | month=November | year=2004 | pmid=15611679 | doi=10.1016/S0755-4982(04)98952-X }}</ref>
===Microscopic findings===
Cross sections of muscle reveal muscle fascicles with small, shrunken polygonal muscle fibers on the periphery of a fascicle surrounding central muscle fibers of normal, uniform size.
Aggregates of mature [[lymphocytes]] with small, dark nuclei and scant cytoplasm are seen surrounding vessels.  Other inflammatory cells are distinctly uncommon. [[Immunohistochemistry]] can be used to demonstrate that both B- and T-cells are present in approximately equal numbers.<ref>Benveniste O, Squier W, Boyer O, Hilton-Jones D, Herson S. ''Presse Med''. '''2004''' Nov 20;33(20):1444-50. PMID: 15611679</ref> <ref>Nirmalananthan N, Holton JL, Hanna MG. Is it really myositis? A consideration of the differential diagnosis. ''Curr Opin Rheumatol''. '''2004''' Nov;16(6):684-91.</ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Autoimmune diseases]]
[[Category:Autoimmune diseases]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]
[[Category:Signs and symptoms]]

Latest revision as of 18:44, 3 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The underlying mechanism of dermatomyositis is conjectured to be complement-mediated damage of the microscopic vessels with muscle atrophy and lymphocytic inflammation secondary to tissue ischemia. On microscopy, both B-cell and T-cell infiltrate are seen.

Pathophysiology

On the muscle biopsy, there are two classic microscopic findings of dermatomyositis. They are:

  • A mixed B- and T-cell perivascular inflammatory infiltrate
  • Perifascicular muscle fiber atrophy

Dermatomyositis is associated with autoantibodies, especially anti-Jo1 antibody.[1]

Mechanism

The mechanism is conjectured to be complement-mediated damage of microscopic vessels with muscle atrophy and lymphocytic inflammation secondary to tissue ischemia.[2]

Microscopic findings

Cross sections of muscle reveal muscle fascicles with small, shrunken polygonal muscle fibers on the periphery of a fascicle surrounding central muscle fibers of normal, uniform size.

Aggregates of mature lymphocytes with small, dark nuclei and scant cytoplasm are seen surrounding vessels. Other inflammatory cells are distinctly uncommon. Immunohistochemistry can be used to demonstrate that both B- and T-cells are present in approximately equal numbers.[3] [4]

References

  1. Ghirardello, A (2006). "Clinical implications of autoantibody screening in patients with autoimmune myositis". Autoimmunity. 39 (3): 217–221. doi:10.1080/08916930600622645. PMID 16769655. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  2. Benveniste, O (2004). "Pathogenesis of primary inflammatory myopathies". Presse Médicale. 33 (20): 1444–1450. doi:10.1016/S0755-4982(04)98952-X. PMID 15611679. Unknown parameter |coauthors= ignored (help); Unknown parameter |month= ignored (help)
  3. Benveniste O, Squier W, Boyer O, Hilton-Jones D, Herson S. Presse Med. 2004 Nov 20;33(20):1444-50. PMID: 15611679
  4. Nirmalananthan N, Holton JL, Hanna MG. Is it really myositis? A consideration of the differential diagnosis. Curr Opin Rheumatol. 2004 Nov;16(6):684-91.

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